Comparison of Severity of Pain and Electrophysiological Severity Degree in Patients with Carpal Tunnel Syndrome

Abstract

INTRODUCTION[|]Carpal tunnel syndrome (CTS) is the most common and best studied of all focal neuropathies. CTS is a clinical syndrome of numbness, tingling, burning, and/or pain associated with localized compression of the median nerve at the wrist.[¤]METHODS[|]A total of 49 hands of 32 patients who presented at the electrophysiology laboratory of the clinic due to suspected CTS were prospectively enrolled in the study. The patients were evaluated using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and a visual analog scale (VAS). The LANSS pain scale is an instrument designed for use in a clinical setting to identify patients whose pain is dominated by neuropathic mechanisms. VAS is a subjective register of pain: On a 100-mm horizontal scale, 0 indicates no pain, while 100 indicates maximum pain. The patients were diagnosed using electrophysiology and grouped as mild, moderate, and severe CTS. LANSS pain scale values above 12 and below 12 were compared according to the severity of CTS. The VAS was applied separately to the right hand and left hand. LANSS and VAS results were compared separately.[¤]RESULTS[|]The LANSS pain scale value was found to be 12 or more in cases of mild and severe CTS. The response to the LANSS question related to discoloration (item 2) was greater in the patients with a LANSS score ≥12 (p=0.008), and similarly, the allodynia (item 6) response was significantly higher in the same group (p=0.010). Except for these 2 items, there was no significant difference between patients with a LANSS score of <12 or ≥12 in terms of the results of the scale. The assessment of the electrophysiological severity of the disease and the VAS score was statistically significant in both the right and left hand (p=0.001, p=0.009). When the LANSS and VAS results were compared, a statistical correlation was identified in the right hand between LANSS discoloration (item 2) (p=0.029) and the total LANSS score (p=0.049).[¤]DISCUSSION AND CONCLUSION[|]Other than allodynia, the LANSS pain scale did not show any significant correlation with electrophysiological severity in patients with CTS. In the group with a LANSS score of ≥12, the responses to item 2 (discoloration) and item 6 (allodynia) were significantly higher. VAS was statistically more significant for identifying electrophysiological severity. These results indicate that the use of VAS in daily practice is confirmed. Additional studies conducted with more detailed tests and a larger number of patients will enable patient follow-up treatment without the need for repeated electroneuromyography examinations.[¤]

Keywords

• carpal tunnel syndrome
• electroneuromyography; leeds assessment of neuropathic symptoms and signs; visual analog scale.